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Nursing Home Checklist Nursing homes are for individuals who are no longer able to live independently, or in an assisted setting. Generally, these homes are for those who have medical needs and require skilled nursing 24 hours a day. These homes provide nursing care, access to physicians, medication, social work, physical therapy, occupational therapy and recreational services. When searching for a nursing facility, it is important to evaluate the services that are included, and those that require additional payment. Use this checklist as a guide.
General information: 1. Name of facility/address: ___________________________________________________________
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2. Name of administrator: ___________________________________________________________ 3. Name of owner (if private): ___________________________________________________________
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4. Licensure and/or accreditation and/or certification: ___________________________________________________________ ___________________________________________________________
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5. Waiting period for admission: ___________________________________________________________
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6. Eligibility for admission: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 7. Is the appropriate bed available for your loved one’s needs? ___________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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8. How many beds are in the facility? What is the staff/resident ratio? ___________________________________________________________ ___________________________________________________________ 9. Are physical restraints used? ___________________________________________________________ 10. Are there family meetings that I can attend? ___________________________________________________________ 11. Does the laundry service include personal items (clothes, underwear)? ___________________________________________________________ 12. Are there religious, cultural and/or language services available? ___________________________________________________________
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13. Grievance process: ___________________________________________________________ ___________________________________________________________
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14. Emergency procedures: ___________________________________________________________ ___________________________________________________________ 15. Smoking facility? Where do residents smoke? ___________________________________________________________
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16. Visitor policy: ___________________________________________________________ ___________________________________________________________
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17. Parking available: ___________________________________________________________ 18. Can my loved one still use their personal physician? ___________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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19. Do you arrange for medication delivery? ___________________________________________________________ ___________________________________________________________
20. How do you care for patients with Alzheimer’s/Dementia? ___________________________________________________________ ___________________________________________________________ a. Is the facility locked to prevent wandering? _____________________________________________________ _____________________________________________________ b. How do you provide for supervised time outdoors? _____________________________________________________ _____________________________________________________
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Staff: 1. Is there a physician on staff? How often does he/she visit the facility? How often will he/she evaluate my loved one? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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2. Is there a nurse on staff? How often is she/he present at the facility? How often will he/she evaluate my loved one? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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3. How do I arrange to have my loved one evaluated or seen by the physician or nurse or other professional? Is there an additional fee involved? ___________________________________________________________ ___________________________________________________________ 4. Staff training/licenses/background checks: ___________________________________________________________ ___________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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5. Ratio of staff to residents? ___________________________________________________________ 6. How often are there shift changes? Does my loved one have one case manager/nurse? ___________________________________________________________ 7. Additional staffing (nurse’s aide, social worker, occupational therapist, recreation therapist/activities director, physical therapist, physician, pharmacist, etc.)? Does my loved one have access to these staff members? Is there an additional fee? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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8. If there is a medical emergency, how fast does my loved one receive assistance? From whom? Is there an additional fee? How am I notified if my loved one is hospitalized? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
skilled nursing nurse’s aides/support workers social work hospice/palliative care
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Services offered:
recreation/activities physical therapy occupational therapy physician pharmacist
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Fees: 1. Rate structures:
a. Medicare and/or Medicaid: _____________________________________________________ b. Flat monthly fee that is all inclusive: _____________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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2. Additional fees: a. Application fee: _____________________________________________________ b. Assessment fee : _____________________________________________________ c. Security deposit: _____________________________________________________ d. Community fee: _____________________________________________________ e. Another facility specific fee: _____________________________________________________ 3. Third party payments:
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a. Medicare/Medicaid program: _____________________________________________________ b. Private insurance program: _____________________________________________________ c. Programs for low income applicants or if applicant’s funds are exhausted: _____________________________________________________
4. Cancellation fee? Fee if I am discharged or decide to move: ___________________________________________________________ ___________________________________________________________
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5. What happens if my loved one’s insurance coverage runs out? How far in advance am I notified? Is there someone that can help me to make other arrangements and discuss the options with me? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Make sure to ask whether these fees are refundable if you change your mind or leave the facility before the intended date.
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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Unit Type: In most skilled nursing facilities, the rooms are shared and have 2-3 people per room. There is often an additional fee above what the insurance will cover if you want a private room. 1. 2. 3. 4. 5. 6. 7. 8.
Are the rooms private?________________________________________ Studio: ____________________________________________________ One bedroom: ______________________________________________ Two bedroom: ______________________________________________ Half bathroom (toilet and sink): _________________________________ Fully furnished: _____________________________________________ Floors of unit availability:______________________________________ Access to elevator: __________________________________________
Meals:
Dining hall: _________________________________________________ Room delivery: ______________________________________________ Guest meals:________________________________________________ Fees:______________________________________________________
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1. 2. 3. 4.
Cable TV hookup Basic cable Local phone service Furnished Television
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1. 2. 3. 4. 5.
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Amenities:
Included
/
Not included
Medication management:
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1. Medication included in rate a. Details: _____________________________________________________ _____________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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2. Not included in rate a. Fees: ________________________________________________
b. Details: _____________________________________________________ _____________________________________________________ _____________________________________________________ Additional paid services:
Shopping: _________________________________________________ Beauty shop/barber: _________________________________________ Escort services: ____________________________________________ Supplies (toiletries, incontinence care, etc.): ______________________ Private nursing care: _________________________________________
Personal care: 1. Bathing
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1. 2. 3. 4. 5.
Frequency: _____ times a day/week
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2. Ambulation/exercise
Frequency: _____ times a week
3. Weight monitoring
Frequency: _____ times a week/month
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4. How is it decided when bathing will occur? Can the resident decide? __________________________________________________________ __________________________________________________________
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5. How are you alerted when the resident wants to eat, drink or use the restroom? __________________________________________________________ __________________________________________________________
6. What is the fee if I want personal care more frequently than provided? __________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.
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Ask the following: 1. If my loved one becomes ill, how am I informed? ___________________________________________________________ ___________________________________________________________ 2. Does my loved one receive assistance with transportation to and from the hospital and/or medical appointments? ___________________________________________________________ ___________________________________________________________
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3. What happens if my loved one becomes ill and need more intensive care? Does she/he have to move? Is there another floor that he/she can transfer to that offers more assistance? Is there assistance with this process? ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
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Your impressions:
Good
Fair
Poor
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1. Interaction between staff and the residents 2. Cleanliness 3. Public areas 4. Rooms 5. Quietness 6. Dining area/food 7. Activity availability 8. Residents look clean and groomed
Other: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________
Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST Š2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without prior written permission.